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Washington rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.68 / $31.16 / $32.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $17.68 / $18.85
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.02 / $73.53 / $156.40
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $26.53 / $78.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $15.17 / $43.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $19.72
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $20.10 / $48.24
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.46 / $94.99 / $166.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.54 / $41.53 / $78.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.02 / $71.48 / $151.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07